Cited by 417Stroke Rehabilitation and RecoveryMedical Practices and RehabilitationDysphagia Assessment and Management

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Impact of intensity of practice after stroke: Issues for consideration

Kwakkel, Gert·2006·Disability and Rehabilitation

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Abstract

PURPOSE: The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills. Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined. DISCUSSION AND CONCLUSION: Although, there is strong evidence that early augmented exercise therapy time (expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.

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Authors: Kwakkel, G.
Affiliations: University Medical Center Utrecht (NL)
Corresponding author: Kwakkel, Gert
ORCID: Kwakkel, Gert
Venue: Disability and Rehabilitation
Publisher: Informa UK Limited
Published: 2006-01
Volume: 28
Issue: 13-14
Pages: 823-830
ISSN: 0963-8288 (ISSN-L)
1464-5165
DOI: 10.1080/09638280500534861
OpenAlex: W2135838445
Cited by: 417
References: 58
Citations by year: 2026: 10 · 2025: 5 · 2024: 11 · 2023: 28 · 2022: 29 · 2021: 21 · 2020: 17 · 2019: 23 · 2018: 24 · 2017: 14 · 2016: 24 · 2015: 30 · 2014: 37 · 2013: 19 · 2012: 21
FWCI: 3.51
Type: journal article
Language: en
Open access: closed
Locations: Disability and Rehabilitation (publishedVersion)
PubMed (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
Pure Amsterdam UMC (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: ZonMw
Topics: Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords: stroke rehabilitation, intensive rehabilitation, dose-response relationship, patient selection, functional recovery, neurophysiological mechanisms, biomechanical mechanisms
MeSH terms: Stroke Rehabilitation, Activities of Daily Living, Exercise Therapy, Humans, Motor Activity, Prognosis, Rehabilitation, Randomized Controlled Trials as Topic, Treatment Outcome, Recovery of Function, Physical Therapy Modalities

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